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Ebob Besem E O M, Chestnutt EG, Donovan L, Stratil AS, Counihan H, Nkfusai CN, Hawkings H, Homolova B, Maxwell K, Baker K, Zoungrana Y, Tanue EA, Ayuk G, Modjenpa NB, Metuge A, Nganmou I, Achu D, Wanji S, Berryman E, Omam LA. Exploring existing malaria services and the feasibility of implementing community engagement approaches amongst conflict-affected communities in Cameroon: a qualitative study. Malar J 2024; 23:155. [PMID: 38769514 PMCID: PMC11107007 DOI: 10.1186/s12936-024-04934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Cameroon is one of the countries with the highest burden of malaria. Since 2018, there has been an ongoing conflict in the country, which has reduced access to healthcare for populations in affected regions, and little is known about the impact on access to malaria services. The objective of this study was to understand the current situation regarding access to malaria services in Cameroon to inform the design of interventions to remove barriers and encourage the use of available services. METHODS A qualitative research study was carried out to understand the barriers preventing communities accessing care, the uptake of community health worker (CHW) services, and to gather perceptions on community engagement approaches, to assess whether these could be an appropriate mechanism to encourage uptake of community health worker (CHW) services. Twenty-nine focus group discussions and 11 in-depth interviews were carried out between May and July 2021 in two regions of Cameroon, Southwest and Littoral. Focus group discussions were held with CHWs and community members and semi-structured, in-depth interviews were conducted with key stakeholders including regional government staff, council staff, community leaders and community-based organisations. The data were analysed thematically; open, descriptive coding was combined with exploration of pre-determined investigative areas. RESULTS The study confirmed that access to healthcare has become increasingly challenging in conflict-affected areas. Although the Ministry of Health are providing CHWs to improve access, several barriers remain that limit uptake of these services including awareness, availability, cost, trust in competency, and supply of testing and treatment. This study found that communities were supportive of community engagement approaches, particularly the community dialogue approach. CONCLUSION Communities in conflict-affected regions of Cameroon continue to have limited access to healthcare services, in part due to poor use of CHW services provided. Community engagement approaches can be an effective way to improve the awareness and use of CHWs. However, these approaches alone will not be sufficient to resolve all the challenges faced by conflict-affected communities when accessing health and malaria services. Additional interventions are needed to increase the availability of CHWs, improve the supply of diagnostic tests and treatments and to reduce the cost of treatment for all.
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Affiliation(s)
- Margaret Ebob Besem E O
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, Cameroon
| | | | - Laura Donovan
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Ann-Sophie Stratil
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Helen Counihan
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Claude Ngwayu Nkfusai
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
- Department of Public Health, School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban, South Africa
| | - Helen Hawkings
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Blanka Homolova
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Kolawole Maxwell
- Malaria Consortium Nigeria, No 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja, FCT, Nigeria
| | - Kevin Baker
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
- Karolinksa Institute, Nobels Väg 15 A, 171 77, Stockholm, Sweden
| | - Yakouba Zoungrana
- Malaria Consortium Nigeria, No 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja, FCT, Nigeria
| | - Elvis Asangbeng Tanue
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, Cameroon
- Reach Out Cameroon (REO), P.O Box 88, Buea, Cameroon
| | - Glennise Ayuk
- Reach Out Cameroon (REO), P.O Box 88, Buea, Cameroon
| | | | - Alain Metuge
- Reach Out Cameroon (REO), P.O Box 88, Buea, Cameroon
| | | | - Dorothy Achu
- National Malaria Control Programme, Ministry of Public Health, Yaoundé, Cameroon
| | - Samuel Wanji
- Department for Microbiology and Parasitology at the University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Elizabeth Berryman
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK.
| | - Lundi-Anne Omam
- Reach Out Cameroon (REO), P.O Box 88, Buea, Cameroon
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Pfledderer CD, von Klinggraeff L, Burkart S, da Silva Bandeira A, Lubans DR, Jago R, Okely AD, van Sluijs EMF, Ioannidis JPA, Thrasher JF, Li X, Beets MW. Consolidated guidance for behavioral intervention pilot and feasibility studies. Pilot Feasibility Stud 2024; 10:57. [PMID: 38582840 PMCID: PMC10998328 DOI: 10.1186/s40814-024-01485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/26/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND In the behavioral sciences, conducting pilot and/or feasibility studies (PFS) is a key step that provides essential information used to inform the design, conduct, and implementation of a larger-scale trial. There are more than 160 published guidelines, reporting checklists, frameworks, and recommendations related to PFS. All of these publications offer some form of guidance on PFS, but many focus on one or a few topics. This makes it difficult for researchers wanting to gain a broader understanding of all the relevant and important aspects of PFS and requires them to seek out multiple sources of information, which increases the risk of missing key considerations to incorporate into their PFS. The purpose of this study was to develop a consolidated set of considerations for the design, conduct, implementation, and reporting of PFS for interventions conducted in the behavioral sciences. METHODS To develop this consolidation, we undertook a review of the published guidance on PFS in combination with expert consensus (via a Delphi study) from the authors who wrote such guidance to inform the identified considerations. A total of 161 PFS-related guidelines, checklists, frameworks, and recommendations were identified via a review of recently published behavioral intervention PFS and backward/forward citation tracking of a well-known PFS literature (e.g., CONSORT Ext. for PFS). Authors of all 161 PFS publications were invited to complete a three-round Delphi survey, which was used to guide the creation of a consolidated list of considerations to guide the design, conduct, and reporting of PFS conducted by researchers in the behavioral sciences. RESULTS A total of 496 authors were invited to take part in the three-round Delphi survey (round 1, N = 46; round 2, N = 24; round 3, N = 22). A set of twenty considerations, broadly categorized into six themes (intervention design, study design, conduct of trial, implementation of intervention, statistical analysis, and reporting) were generated from a review of the 161 PFS-related publications as well as a synthesis of feedback from the three-round Delphi process. These 20 considerations are presented alongside a supporting narrative for each consideration as well as a crosswalk of all 161 publications aligned with each consideration for further reading. CONCLUSION We leveraged expert opinion from researchers who have published PFS-related guidelines, checklists, frameworks, and recommendations on a wide range of topics and distilled this knowledge into a valuable and universal resource for researchers conducting PFS. Researchers may use these considerations alongside the previously published literature to guide decisions about all aspects of PFS, with the hope of creating and disseminating interventions with broad public health impact.
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Affiliation(s)
- Christopher D Pfledderer
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, 78701, USA.
- Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, 78701, USA.
| | | | - Sarah Burkart
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
| | | | - David R Lubans
- College of Human and Social Futures, The University of Newcastle Australia, Callaghan, NSW, 2308, Australia
| | - Russell Jago
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 1QU, UK
| | - Anthony D Okely
- Faculty of Arts, Social Sciences and Humanities, School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia
| | | | - John P A Ioannidis
- Department of Medicine, Stanford University, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
- Department of Statistics, Stanford University, Stanford, CA, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - James F Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
| | - Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
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Pfledderer CD, von Klinggraeff L, Burkart S, da Silva Bandeira A, Lubans DR, Jago R, Okely AD, van Sluijs EM, Ioannidis JP, Thrasher JF, Li X, Beets MW. Expert Perspectives on Pilot and Feasibility Studies: A Delphi Study and Consolidation of Considerations for Behavioral Interventions. RESEARCH SQUARE 2023:rs.3.rs-3370077. [PMID: 38168263 PMCID: PMC10760234 DOI: 10.21203/rs.3.rs-3370077/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background In the behavioral sciences, conducting pilot and/or feasibility studies (PFS) is a key step that provides essential information used to inform the design, conduct, and implementation of a larger-scale trial. There are more than 160 published guidelines, reporting checklists, frameworks, and recommendations related to PFS. All of these publications offer some form of guidance on PFS, but many focus on one or a few topics. This makes it difficult for researchers wanting to gain a broader understanding of all the relevant and important aspects of PFS and requires them to seek out multiple sources of information, which increases the risk of missing key considerations to incorporate into their PFS. The purpose of this study was to develop a consolidated set of considerations for the design, conduct, implementation, and reporting of PFS for interventions conducted in the behavioral sciences. Methods To develop this consolidation, we undertook a review of the published guidance on PFS in combination with expert consensus (via a Delphi study) from the authors who wrote such guidance to inform the identified considerations. A total of 161 PFS-related guidelines, checklists, frameworks, and recommendations were identified via a review of recently published behavioral intervention PFS and backward/forward citation tracking of well-know PFS literature (e.g., CONSORT Ext. for PFS). Authors of all 161 PFS publications were invited to complete a three-round Delphi survey, which was used to guide the creation of a consolidated list of considerations to guide the design, conduct, and reporting of PFS conducted by researchers in the behavioral sciences. Results A total of 496 authors were invited to take part in the Delphi survey, 50 (10.1%) of which completed all three rounds, representing 60 (37.3%) of the 161 identified PFS-related guidelines, checklists, frameworks, and recommendations. A set of twenty considerations, broadly categorized into six themes (Intervention Design, Study Design, Conduct of Trial, Implementation of Intervention, Statistical Analysis and Reporting) were generated from a review of the 161 PFS-related publications as well as a synthesis of feedback from the three-round Delphi process. These 20 considerations are presented alongside a supporting narrative for each consideration as well as a crosswalk of all 161 publications aligned with each consideration for further reading. Conclusion We leveraged expert opinion from researchers who have published PFS-related guidelines, checklists, frameworks, and recommendations on a wide range of topics and distilled this knowledge into a valuable and universal resource for researchers conducting PFS. Researchers may use these considerations alongside the previously published literature to guide decisions about all aspects of PFS, with the hope of creating and disseminating interventions with broad public health impact.
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Affiliation(s)
| | | | - Sarah Burkart
- University of South Carolina Arnold School of Public Health
| | | | | | - Russ Jago
- University of Bristol Population Health Sciences
| | | | | | | | | | - Xiaoming Li
- University of South Carolina Arnold School of Public Health
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Nieto-Sanchez C, Hatley DM, Grijalva MJ, Peeters Grietens K, Bates BR. Communication in Neglected Tropical Diseases' elimination: A scoping review and call for action. PLoS Negl Trop Dis 2022; 16:e0009774. [PMID: 36228006 PMCID: PMC9595560 DOI: 10.1371/journal.pntd.0009774] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/25/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although the practice of communication is often called upon when intervening and involving communities affected by NTDs, the disciplinary framework of health communication research has been largely absent from NTD strategies. To illustrate how practices conceptualized and developed within the communication field have been applied in the context of NTD elimination, we conducted a scoping review focusing on two diseases currently targeted for elimination by the WHO: lymphatic filariasis and Chagas disease. METHODS We examined studies published between 2012 and 2020 in five electronic databases. Selected articles were required to (i) have explicit references to communication in either the abstract, title, or key words; (ii) further elaborate on the search terms (communication, message, media, participation and health education) in the body of the article; and (iii) sufficiently describe communication actions associated to those terms. Using the C-Change Socio-Ecological Model for Social and Behavior Change Communication as a reference, the articles were analysed to identify communication activities, theoretical frameworks, and/or rationales involved in their design, as well as their intended level of influence (individual, interpersonal, community, or enabling environment). RESULTS AND IMPLICATIONS A total of 43 articles were analysed. Most interventions conceptualized communication as a set of support tools or supplemental activities delivering information and amplifying pre-defined messages aimed at increasing knowledge, encouraging community involvement, promoting individual behavior change, or securing some degree of acceptability of proposed strategies. Although important attempts at further exploring communication capabilities were identified, particularly in participation-based strategies, for most studies, communication consisted of an underdeveloped and under-theorized approach. We contend that a more complex understanding of the capacities offered by the health communication field could help attain the biomedical and social justice goals proposed in NTD elimination strategies. Three ways in which the field of health communication could further enhance NTD efforts are presented: informing interventions with theory-based frameworks, exploring the political complexity of community participation in specific contexts, and identifying conceptualizations of culture implied in interventions' design. CONCLUSION This article is a call to action to consider the resources offered by the health communication field when researching, designing, or implementing NTD interventions.
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Affiliation(s)
- Claudia Nieto-Sanchez
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - David M. Hatley
- Department of Epidemiology, University of London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mario J. Grijalva
- Infectious and Tropical Disease Institute (ITDI), Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, United States of America
- Center for Research in Health in Latin America (CISeAL), Facultad de Ciencias Exactas y Naturales, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Koen Peeters Grietens
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Nagasaki, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Benjamin R. Bates
- Infectious and Tropical Disease Institute (ITDI), Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, United States of America
- Center for Research in Health in Latin America (CISeAL), Facultad de Ciencias Exactas y Naturales, Pontifical Catholic University of Ecuador, Quito, Ecuador
- School of Communication Studies, Ohio University, Athens, Ohio, United States of America
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